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Balancing Value & Burden:
CMS Electronic Quality Reporting
Session #199, February 14, 2019
Michelle Schreiber, MD, Director, Quality Measurement and Value-Based Incentives Group
Debbie Krauss, MS BSN RN, Nurse, Division of Electronic and Clinician Quality
The Center for Clinical Standards & Quality, Centers for Medicare & Medicaid Services
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Michelle Schreiber, MD
Centers for Medicare & Medicaid Services
Has no real or apparent conflicts of interest to report.
Conflict of Interest
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Debbie Krauss, MS BSN RN, Nurse
Centers for Medicare & Medicaid Services
Has no real or apparent conflicts of interest to report.
Conflict of Interest
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• Introduction
• eCQM Strategy Project
– Timeline of Activities
– Approach to Learn Stakeholder Experiences
– Overview of Burdens and Recommendations
– Initiatives underway to increase value and reduce burden
– Collaborative Measure Development Workspace
– Data Element Repository
– Demonstration
– Resources
• Question & Answer Session
Agenda
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• Learn how CMS has engaged with stakeholders to understand the
burden associated with measure implementation and electronic
quality reporting.
• Identify initiatives underway to increase the value and reduce
burden associated with measure development, implementation,
and reporting.
• Understand how the Collaborative Measure Development
Workspace can help improve value through increased stakeholder
engagement and transparency into the development process.
Learning Objectives
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• Primary goal of Administration:
Remove obstacles that get in the
way of the time clinicians spend
with their patients
• Patients Over Paperwork
– Shows CMS’s commitment to
patient-centered care and
improving beneficiary
outcomes
– Includes several major tasks
aimed at reducing burden for
clinicians
– Motivates CMS to evaluate its
regulations to see what could
be improved
Introduction
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What is Meaningful Measures Initiative?
• Launched in 2017, the purpose of the Meaningful Measures
initiative is to:
• Improve outcomes for patients
• Reduce data reporting burden and costs on clinicians and other
health care providers
• Focus CMS’s quality measurement and improvement efforts to
better align with what is most meaningful to patients
A New Approach to Meaningful
Outcomes
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Problem Statement
• Providers participating in CMS quality and value-based
purchasing programs have shared challenges they experience
related to the complexity and high burden of electronic
clinical quality measure implementation, data capture, and
reporting.
Project Scope
• Measure Development process from concept to the MUC list
• Electronic Clinical Quality Reporting requirements and
processes from eCQM implementation to submission
• Tools for Development and Reporting
eCQM Strategy Project
Problem Statement and Project Scope
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eCQM Strategy Project
Timeline and Activities
October 2017 –
November 2017
Project Started
Environmental Scan
Completed
User-Centered Design
Team Training
Stakeholder
Engagement Planning
December 2017 –
March 2018
Stakeholder Events
Site Visits
ONC Annual Meeting
CMS Quality
Conference
HIMSS 2018
Conference
April 2018 – June 2018
Findings and
Recommendations
Compiled
Socialization of
Recommendations
with CMS Quality Staff
and Leadership
July 2018 – Present
Implementation
Planning Discussions
with CMS, Contractor
Staff, and External
Partners
Collaborative Measure
Development
Workspace Planning
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• Training completed by User-Centered Design Experts
• Focus on engaging directly with hospitals, providers, and
other stakeholders to:
– Hear their experiences
– Understand what is working well
– Understand where there are opportunities for
improvement
• Journey mapping to visualize the provider processes and
help identify gaps, moments of frustration/delight, etc., and
thus lead to insights for improvement
eCQM Strategy Project
Approach to Learn Stakeholder Experiences
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• Engaged with the following stakeholders:
– Clinicians
– Hospitals
– Measure developers
– Health IT vendors
– Data submission vendors
– CMS measure, policy-related, & Information Systems Group (ISG)
staff
– ONC
• Engagement venues: site visits, listening sessions, face to face
discussions at CMS, CMS Quality Conference, ONC Annual Meeting, and
HIMSS 2018
• Focus on experiences and processes of stakeholders
• Review of current state processes within CMS
eCQM Strategy Project
Approach to Learn Stakeholder Experiences
Walters Wiggles ZION
“I think I can, I think I can!?!?!?”
Success!! The Relaxing Descent
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eCQM Strategy Project
Approach to Learn Stakeholder Experiences
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• Happy with the work: given green light across the board to implement
recommendations
• Implement a user-centered design focus is essential in all efforts
• Collaborate and convene with stakeholders and across programs for data
submission which will result in most efficient and effective processes
• Work collectively across CMS groups to breakdown barriers and achieve
aligned goals
• Conduct continuous improvement for communication, education, and
outreach to ensure stakeholders can easily understand program
requirements
eCQM Strategy Project
General Recommendations from CCSQ Leadership
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• Measure Development
– Convened a working session in September with measure development
stakeholders to review related recommendations
– Measure developers launched initiative to increase focus on clinical
workflows
– Exploring value and expanded use of hybrid measures, which are
clinical quality measures that link patient-level electronically specified
EHR data to CMS claims data for the purpose of enhancing risk
adjustment.
• Measure Implementation and Reporting
– Measure-level webinars planned for both Eligible Clinicians and
Eligible Hospitals to kicked off in October and run through February
– Convened a CMS working session in October to discuss CMS
program opportunities
– Planned Collaborative Measure Development (CMD) Workspace
– Improvements to Inpatient Quality Reporting System are in progress
eCQM Strategy Project
Progress on Implementing Recommendations
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• Follow-up with External Groups
– Held discussions with non-CMS organizations to share
recommendations that were within their respective oversight. Those
organizations include:
– Health IT Vendors
– National Library of Medicine/Value Set Authority Center
– National Quality Forum
– Electronic Health Records Association
• CMS Activities to Support Implementers
– Working on improvements to QPP and IQR Help Desks
– Delivered webinars to assist providers with understanding program
requirements, Quality Reporting Document Architecture (QRDA)
Implementation Guide and troubleshooting, eCQM data validation,
available tools and resources, and Pre-Submission Validation
Application (PSVA) overview
eCQM Strategy Project
Progress on Implementing Recommendations (Cont.)
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Burden Reduction Using Electronic Data
• CCSQ is testing Fast Healthcare Interoperability Resources
(FHIR®) for Quality Measurement
– Da Vinci Project
• Alignment with the community around adoption of FHIR,
including Providers, ONC, Health IT Vendors, Payers
– HL7 Connectathons
• Testing the submission of quality data using FHIR
• Testing the calculation of eCQMs using FHIR
– Application Programming Interfaces (API) to create a
seamless exchange of quality data from an EHR
– FHIR-based Certification processes and tools
eCQM Strategy Project
What’s new for Measure Development,
Implementation, & Reporting?
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Live on
December 28, 2018
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• Hosted on the Electronic Clinical Quality Improvement (eCQI)
Resource Center
• Set of interconnected resources, tools, and processes for eCQMs
• Promotes transparency and better interaction across stakeholder
communities interested in developing and implementing more
harmonized, accurate, and meaningful electronic clinical quality
measures.
• Provides access to the eCQM Data Element Repository, an
online, searchable tool that provides all the data elements
associated with eCQMs used in CMS Quality Reporting
Programs.
CMD Workspace: Definition
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Backup Slides
Collaborative Measure Development
Workspace
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